Page 1183 - draft

UEI was administered: UOA was UAM was UG was
administered: administered: administered:
iii. Trigger that iii. Type of person visitor);
precipitated administering ii. Any previously
DRAFT
allergic episode; the opioid known
iv. Location where antagonist diagnosis of
symptoms (school nurse or asthma;
developed; trained
v. Number of personnel); and iii. Trigger that
precipitated
doses iv. Any other respiratory
administered; information distress, if
vi. Type of person required by identifiable;
ISBE on the
administering
epinephrine form. iv. Location where
(school nurse, symptoms
trained developed;
personnel, v. Number of
student); and doses
vii. Any other administered;
information vi. Type of person
required by administering
ISBE on the the asthma
form. medication
(school nurse,
trained
personnel or
student);
vii. Outcome of the
asthma
medication
administration;
and
viii. Any other
information
required by
ISBE on the
form.

Determine how the District will identify the student populations whose parents/guardians:
1. Have not completed and signed an SMA Form, or

2. Have not provided asthma medication, an epinephrine injector, opioid antagonist, and/or
glucagon, as applicable to the student, for a student for use at school, even though they
have completed the SMA Form.
Determine when the school nurse will provide or administer the UAM, UEIs, UOAs, and/or
UG, as applicable, to students.

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